eHealth Meets the Constitution

An article published in yesterday’s Canadian Medical Association Journal notes that “confusion and disarray appear to be the only form of national standards in operation within health information record-keeping circles“. Why does this situation exist? Dr. Alexander Jadad, Canada Research Chair in ehealth innovation at the University of Toronto, is quoted as saying, “We don’t really have any federal governance” and “governments have to figure out how to make people comply with these standards“.

While I have been making a similar plea for national standards in various forums, I think that people need to keep in mind the political realities. To start, and perhaps most importantly, healthcare, along with many other matters, is a provincial responsibility. This division of responsibilities drives many aspects of federal / provincial relations and makes it very difficult for the federal government to take an active role in anything related to healthcare. Indeed, Infoway is a creative response to this dilemma that attempts to direct federal money in a manner that respects provincial responsibilities. Any attempt to drive national standards must consider the federated nature of Canadian laws and politics.

So …. where should the leadership about which everyone is yelling about come from? Infoway? Health Canada? A new organization? Or, do we start at the provincial level? Maybe the new eHealth Ontario CEO, Greg Reed, should cease work on provincial eHealth standards and immediately work with Infoway to adapt Pan-Canadian standards instead. As the largest province such a move not only sends a strong signal to other provinces but also creates a market of sufficient size for vendors to come on side.

3 responses to “eHealth Meets the Constitution”

I read the same article and had a somewhat different reaction. In the past you have defended the role and actions of Infoway, and rightfully so. As much as I have mixed feelings about the organization, I have never disagreed with the concept of having a national funding champion. The federated nature of the Canadian healthcare system is not going away soon, and as such a pan-Canadian organization is essential to ensure that we are not creating yet more silos in Canada. My issue with CHI has more to do with what I believe is a fundamental standards error that must be fixed. By letting the provinces set their own EMR programs, CHI has missed the boat for setting up a single national standard and certification process and body similar to CCHIT in the US. The question for me is now the horse is out of the barn, what can CHI “realistically” do in order to address the situation. I know they have a strategy, but it sure would be nice if they let the public know what it is. Complete transparency would be a good first step in solving this rather thorny issue.

On the surface, your argument re: national standards make sense. Why did / does Infoway let “province set their own EMR program”? What choice do they have? Infoway is not a policy body and does not / cannot set policy on a wide variety of eHealth related issues including adoption of national standards. There is no ministry or agency that has such authority to the best of my knowledge. Further, remember that they are not for profit organization whose members are the Deputy Ministers of Health for the provinces. Hence, they are compelled to heed provincial wishes. In many ways their hands are tied.

I do agree that more openness and transparency is needed. As you note, I have long supported Infoway as a concept and have applauded many of their efforts. When it comes to openness and transparency, however, I am a harsh critic.